Exploring the Impact of Catechins on Bone Metabolism: A Comprehensive Review of Current Research and Future Directions

Background/Objectives: Degenerative musculoskeletal diseases represent a global health problem due to the progressive deterioration of affected individuals. As a bioactive compound, catechins have shown osteoprotective properties by stimulating osteoblastic cells and inhibiting bone resorption. Thus, this review aimed to address the mechanism of action of catechins on bone tissue. Methods: The search was applied to PubMed without limitations in date, language, or article type. Fifteen articles matched the topic and objective of this review. Results: EGCG (epigallocatechin gallate) and epicatechin demonstrated action on the osteogenic markers RANKL, TRAP, and NF-κβ and expression of BMPs and ALP, thus improving the bone microarchitecture. Studies on animals showed the action of EGCG in increasing calcium and osteoprotegerin levels, in addition to regulating the transcription factor NF-ATc1 associated with osteoclastogenesis. However, it did not show any effect on osteocalcin and RANK. Regarding human studies, EGCG reduced the risk of fracture in a dose-dependent manner. In periodontal tissue, EGCG reduced IL-6, TNF, and RANKL in vitro and in vivo. Human studies showed a reduction in periodontal pockets, gingival index, and clinical attachment level. The action of EGCG on membranes and hydrogels showed biocompatible and osteoinductive properties on the microenvironment of bone tissue by stimulating the expression of osteogenic growth factors and increasing osteocalcin and alkaline phosphate levels, thus promoting new bone formation. Conclusions: EGCG stimulates cytokines related to osteogenes, increasing bone mineral density, reducing osteoclastogenesis factors, and showing great potential as a therapeutic strategy for reducing the risk of bone fractures.

Increased dosage and treatment time of Epigallocatechin-3-gallate (EGCG) negatively affects skeletal parameters in normal mice and Down syndrome mouse models

Bone abnormalities affect all individuals with Down syndrome (DS) and are linked to abnormal expression of DYRK1A, a gene found in three copies in people with DS and Ts65Dn DS model mice. Previous work in Ts65Dn male mice demonstrated that both genetic normalization of Dyrk1a and treatment with ~9 mg/kg/day Epigallocatechin-3-gallate (EGCG), the main polyphenol found in green tea and putative DYRK1A inhibitor, improved some skeletal deficits. Because EGCG treatment improved mostly trabecular skeletal deficits, we hypothesized that increasing EGCG treatment dosage and length of administration would positively affect both trabecular and cortical bone in Ts65Dn mice. Treatment of individuals with DS with green tea extract (GTE) containing EGCG also showed some weight loss in individuals with DS, and we hypothesized that weights would be affected in Ts65Dn mice after EGCG treatment. Treatment with ~20 mg/kg/day EGCG for seven weeks showed no improvements in male Ts65Dn trabecular bone and only limited improvements in cortical measures. Comparing skeletal analyses after ~20mg/kg/day EGCG treatment with previously published treatments with ~9, 50, and 200 mg/kg/day EGCG showed that increased dosage and treatment time increased cortical structural deficits leading to weaker appendicular bones in male mice. Weight was not affected by treatment in mice, except for those given a high dose of EGCG by oral gavage. These data indicate that high doses of EGCG, similar to those reported in some treatment studies of DS and other disorders, may impair long bone structure and strength. Skeletal phenotypes should be monitored when high doses of EGCG are administered therapeutically.

Relationship between Regular Green Tea Intake and Osteoporosis in Korean Postmenopausal Women: A Nationwide Study

Mixed results have been reported regarding whether habitual tea intake affects bone health. This study investigated the relationship between green tea intake and bone mineral density (BMD) in postmenopausal Korean women. We used data from the Korean National Health and Nutrition Examination Surveys from 2008 to 2011 and divided the participants into three groups according to their frequency of green tea intake over the past 12 months. BMD of the lumbar spine, total femur, and femur neck was measured using dual-energy X-ray absorptiometry. The odds ratios (ORs) and 95% confidence intervals (CIs) of osteoporosis and osteopenia according to green tea consumption were analyzed. Participants who did not consume green tea or consumed less than one cup per day were more likely to have osteopenia of the lumbar spine or femur than those who consumed it once to three times a day (OR 1.81 and 1.85, 95% CI, 1.20–2.71; and 1.23–2.77). Moreover, ORs for osteoporosis were 1.91 (95% CI 1.13–3.23) and 1.82 (95% CI 1.09–3.05) in non-consumers and consumers who drank less than one cup per day, respectively, compared with the reference group. These results support that green tea consumption may have benefits on bone health.

Osteoprotective Roles of Green Tea Catechins

Osteoporosis is the second most common disease only secondary to cardiovascular disease, with the risk of fracture increasing with age. Osteoporosis is caused by an imbalance between osteoblastogenesis and osteoclastogenesis processes. Osteoclastogenesis may be enhanced, osteoblastogenesis may be reduced, or both may be evident. Inflammation and high reactive oxygen enhance osteoclastogenesis while reducing osteoblastogenesis by inducing osteoblast apoptosis and suppressing osteoblastic proliferation and differentiation. Catechins, the main polyphenols found in green tea with potent anti-oxidant and anti-inflammatory properties, can counteract the deleterious effects of the imbalance of osteoblastogenesis and osteoclastogenesis caused by osteoporosis. Green tea catechins can attenuate osteoclastogenesis by enhancing apoptosis of osteoclasts, hampering osteoclastogenesis, and prohibiting bone resorption in vitro. Catechin effects can be directly exerted on pre-osteoclasts/osteoclasts or indirectly exerted via the modulation of mesenchymal stem cells (MSCs)/stromal cell regulation of pre-osteoclasts through activation of the nuclear factor kB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) system. Catechins also can enhance osteoblastogenesis by enhancing osteogenic differentiation of MSCs and increasing osteoblastic survival, proliferation, differentiation, and mineralization. The in vitro effects of catechins on osteogenesis have been confirmed in several animal models, as well as in epidemiological observational studies on human subjects. Even though randomized control trials have not shown that catechins provide anti-fracture efficacy, safety data in the trials are promising. A large-scale, placebo-controlled, long-term randomized trial with a tea regimen intervention of optimal duration is required to determine anti-fracture efficacy.

Black Tea Exhibits a Dose-Dependent Response in Saos-2 Cell Mineralization

Higher bone mineral density (BMD) is often associated with greater consumption of black tea (BT). However, the dose–response of BT on mineralization in an osteoblast cell model has not yet been studied. The study objective was to determine the dose-dependent response of BT in Saos-2 cells and investigate changes to several proteins involved in the mineralization process. Mineralization was induced in the presence of BT at concentrations that represent levels likely achieved through daily consumption (0.1, 0.5, 0.75, 1 μg gallic acid equivalents [GAE]/mL) or through supplementation (2, 5, or 10 μg GAE/mL). BT exerted a positive dose–response on bone mineralization, peaking at 1 μg GAE/mL of BT (P < .05). Cellular activity was significantly greater than control with exposure to 2–10 μg GAE/mL of BT (at 24 h) (P < .05) and 1–10 μg GAE/mL (at 48 h) (P < .05), with a peak at 5 μg GAE/mL at 24 and 48 h (P < .05). Protein expression of alkaline phosphatase and ectonucleotide pyrophosphatase/phosphodiesterase-1 were unchanged, whereas a moderate dose of BT (0.75 μg GAE/mL) resulted in greater expression of osteopontin compared with the highest dose (10 μg GAE/mL) (P < .05). Doses of BT from 0.5 to 10 μg GAE/mL resulted in higher antioxidant capacity compared with control (P < .05). In summary, the higher antioxidant capacity, enhanced cell viability, and upregulated mineralization suggest that consumption of BT may have a positive effect on BMD at levels obtained through consumption of tea.

Effect of Long-Term Green Tea Polyphenol Supplementation on Bone Architecture, Turnover, and Mechanical Properties in Middle-Aged Ovariectomized Rats

We investigated the effects of 6-month green tea polyphenols (GTP) supplementation on bone architecture, turnover, and mechanical properties in middle-aged ovariectomized (OVX) rats. Female rats were sham-operated (n = 39, 13/group) or OVX (n = 143, 13/group). Sham-control and OVX-control rats (n = 39) receiving no GTP were assigned for sample collection at baseline, 3, or 6 months. The remaining OVX rats (n = 104) were randomized to 0.15%, 0.5%, 1%, and 1.5% (g/dL) GTP for 3 or 6 months. Blood and bone samples were collected. Relative to the OVX-control group, GTP (1% and 1.5%) lowered serum procollagen type 1 N-terminal propeptide at 3 and 6 months, C-terminal telopeptides of type I collagen at 3 months, and insulin-like growth factor-I at 6 months. GTP did not affect bone mineral content and density. At 6 months, no dose of GTP positively affected trabecular bone volume based on microCT, but a higher cortical thickness and improved biomechanical properties of the femur mid-diaphysis was observed in the 1.5% GTP-treated group. At 3 and 6 months, GTP (0.5%, 1%, and 1.5%) had lower rates of trabecular bone formation and resorption than the OVX-control group, but the inhibitory effects of GTP on periosteal and endocortical bone mineralization and formation at the tibial midshaft were only evident at 3 months. GTP at higher doses suppressed bone turnover in the trabecular and cortical bone of OVX rats and resulted in improved cortical bone structural and biomechanical properties, although it was not effective in preventing the ovariectomy-induced dramatic cancellous bone loss.

Updated association of tea consumption and bone mineral density: A meta-analysis

BACKGROUND

Current studies evaluating the association of tea consumption and bone mineral density (BMD) have yielded inconsistent findings. Therefore, we conducted a meta-analysis to assess the relationship between tea consumption and BMD.

METHODS

The PubMed, Embase, and Cochrane Library databases were comprehensively searched, and a meta-analysis performed of all observational studies assessing the association of tea consumption and BMD. Forest plots were used to illustrate the results graphically. The Q-test and I statistic were employed to evaluate between-study heterogeneity. Potential publication bias was assessed by the funnel plot.

RESULTS

Four cohort, 1 case-control, and 8 cross-sectional studies including a total of 12,635 cases were included. Tea consumption was shown to prevent bone loss [odds ratio (OR): 0.66; 95% confidence interval (CI), 0.47-0.94; P = 0.02], yielding higher mineral densities in several bones, including the lumbar spine [standardized mean difference (SMD): 0.19; 95% CI, 0.08-0.31; P = 0.001], hip (SMD: 0.19; 95% CI, 0.05-0.34; P = 0.01), femoral neck [mean difference (MD): 0.01; 95% CI, 0.00-0.02; P = 0.04], Ward triangle (MD: 0.02; 95% CI, 0.01-0.04; P = 0.001), and greater trochanter (MD: 0.03; 95% CI, 0.02-0.04; P < 0.00001), than the non-tea consumption group.

CONCLUSION

This meta-analysis provided a potential trend that tea consumption might be beneficial for BMD, especially in the lumbar spine, hip, femoral neck, Ward triangle, and greater trochanter, which might help prevent bone loss.

Tea flavonoids for bone health: from animals to humans

Osteoporosis is a skeletal disease characterized by a deterioration of bone mass and bone quality that predisposes an individual to a higher risk of fragility fractures. Emerging evidence has shown that the risk for low bone mass and osteoporosis-related fractures can be reduced by nutritional approaches aiming to improve bone microstructure, bone mineral density, and strength. Tea and its flavonoids, especially those of black tea and green tea, have been suggested to protect against bone loss and to reduce risk of fracture, due to tea's antioxidant and anti-inflammatory properties. Based on the results of animal studies, moderate intake of tea has shown to benefit bone health as shown by mitigation of bone loss and microstructural deterioration as well as improvement of bone strength and quality. Epidemiological studies have reported positive, insignificant, and negative impacts on bone mineral density at multiple skeletal sites and risk of fracture in humans with habitual tea consumption. There are limited human clinical trials that objectively and quantitatively assessed tea consumption and bone efficacy using validated outcome measures in a population at high risk for osteoporosis, along with safety monitoring approach. This review summarizes the current state of knowledge of laboratory animal research, epidemiological observational studies, and clinical trials assessing the skeletal effects of tea and its active flavonoids, along with discussion of relevant future directions in translational research.

Supraphysiological Levels of Quercetin Glycosides are Required to Alter Mineralization in Saos2 Cells

Flavonoid intake is positively correlated to bone mineral density (BMD) in women. Flavonoids such as quercetin exhibit strong anti-oxidant and anti-inflammatory activity that may be beneficial for bone health. Quercetin, previously shown to positively influence osteoblasts, is metabolized into glycosides including rutin and hyperoside. We compared the effects of these glycosides on mineralization in human osteoblast (Saos2) cells. Administration of rutin (≥25 µM) and hyperoside (≥5 µM) resulted in higher mineral content, determined using the alizarin red assay. This was accompanied by higher alkaline phosphatase activity with no cell toxicity. The expression of osteopontin, sclerostin, TNFα and IL6, known stimuli for decreasing osteoblast activity, were reduced with the addition of rutin or hyperoside. In summary, rutin and hyperoside require supraphysiological levels, when administered individually, to positively influence osteoblast activity. This information may be useful in developing nutraceuticals to support bone health.

Differential effects of Epigallocatechin-3-gallate containing supplements on correcting skeletal defects in a Down syndrome mouse model

SCOPE

Down syndrome (DS), caused by trisomy of human chromosome 21 (Hsa21), is characterized by a spectrum of phenotypes including skeletal abnormalities. The Ts65Dn DS mouse model exhibits similar skeletal phenotypes as humans with DS. DYRK1A, a kinase encoded on Hsa21, has been linked to deficiencies in bone homeostasis in DS mice and individuals with DS. Treatment with Epigallocatechin-3-gallate (EGCG), a known inhibitor of Dyrk1a, improves some skeletal abnormalities associated with DS in mice. EGCG supplements are widely available but the effectiveness of different EGCG-containing supplements has not been well studied.

METHODS AND RESULTS

Six commercially available supplements containing EGCG were analyzed, and two of these supplements were compared with pure EGCG for their impact on skeletal deficits in a DS mouse model. The results demonstrate differential effects of commercial supplements on correcting skeletal abnormalities in Ts65Dn mice. Different EGCG-containing supplements display differences in degradation, polyphenol content, and effects on trisomic bone.

CONCLUSION

This work suggests that the dose of EGCG and composition of EGCG-containing supplements may be important in correcting skeletal deficits associated with DS. Careful analyses of these parameters may lead to a better understanding of how to improve skeletal and other deficits that impair individuals with DS.

Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study

BACKGROUND

Observational studies have linked tea drinking, a major source of dietary flavonoids, with higher bone density. However, there is a paucity of prospective studies examining the association of tea drinking and flavonoid intake with fracture risk.

OBJECTIVE

The objective of this study was to examine the associations of black tea drinking and flavonoid intake with fracture risk in a prospective cohort of women aged >75 y.

DESIGN

A total of 1188 women were assessed for habitual dietary intake with a food-frequency and beverage questionnaire. Incidence of osteoporotic fracture requiring hospitalization was determined through the Western Australian Hospital Morbidity Data system. Multivariable adjusted Cox regression was used to examine the HRs for incident fracture.

RESULTS

Over 10 y of follow-up, osteoporotic fractures were identified in 288 (24.2%) women; 212 (17.8%) were identified as a major osteoporotic fracture, and of these, 129 (10.9%) were a hip fracture. In comparison with the lowest tea intake category (≤1 cup/wk), consumption of ≥3 cups/d was associated with a 30% decrease in the risk of any osteoporotic fracture (HR: 0.70; 95% CI: 0.50, 0.96). Compared with women in the lowest tertile of total flavonoid intake (from tea and diet), women in the highest tertile had a lower risk of any osteoporotic fracture (HR: 0.65; 95% CI: 0.47, 0.88), major osteoporotic fracture (HR: 0.66; 95% CI: 0.45, 0.95), and hip fracture (HR: 0.58; 95% CI: 0.36, 0.95). For specific classes of flavonoids, statistically significant reductions in fracture risk were observed for higher intake of flavonols for any osteoporotic fracture and major osteoporotic fracture, as well as flavones for hip fracture (P < 0.05).

CONCLUSION

Higher intake of black tea and particular classes of flavonoids were associated with lower risk of fracture-related hospitalizations in elderly women at high risk of fracture.

Role of (-)-epigallocatechin-3-gallate in the osteogenic differentiation of human bone marrow mesenchymal stem cells: An enhancer or an inducer?

Epidemiological investigations have revealed that the consumption of green tea, which is a rich source of (-)-epigallocatechin-3-gallate (EGCG), is associated with a reduced risk of osteoporosis. A number of in vitro and in vivo studies have also demonstrated that EGCG exerts a significant positive effect on osteogenesis; however, the single effect of EGCG on osteogenic differentiation has been seldom studied. EGCG was hypothesized to function as an enhancer or an inducer. In the present study, the effect of EGCG on the osteogenic differentiation of primary human bone marrow mesenchymal stem cells (hBMSCs), without other additives, was investigated. Three groups of stem cells were analyzed, which included a negative control group (hBMSCs cultured with culture medium only), an experimental group (cells treated with culture medium containing 2.5, 5 and 10 µM EGCG), and a positive control group (cells cultured with osteogenesis-induced culture medium). After 3, 7, 14 and 21 days, cell proliferation, alkaline phosphatase (ALP) activity and the expression of associated osteogenic genes were analyzed. The results revealed that ALP activity and the expression of associated osteogenic genes, with the exception of bone morphogenetic protein 2 (BMP2), were not affected by EGCG treatment alone. These results indicated that EGCG itself had little effect on the osteogenic differentiation of MSCs; however, EGCG was able to enhance osteogenesis in the presence of osteoinductive agents through the upregulation of BMP2 expression. Additionally, EGCG was shown to promote cell growth, demonstrating its safety as a therapeutic agent. Therefore, the present study indicated that treatment with EGCG was dependent on other osteogenic inducers.

Epigallocatechin-3-gallate (EGCG) as a pro-osteogenic agent to enhance osteogenic differentiation of mesenchymal stem cells from human bone marrow: an in vitro study

The proliferation and osteogenic capacity of mesenchymal stem cells (MSCs) needs to be improved for their use in cell-based therapy for osteoporosis. (-)-Epigallocatechin-3-gallate (EGCG), one of the green tea catechins, has been widely investigated in studies of osteoblasts and osteoclasts. However, no consensus on its role as an osteogenic inducer has been reached, possibly because of the various types of cell lines examined and the range of concentrations of EGCG used. In this study, the osteogenic effects of EGCG are studied in primary human bone-marrow-derived MSCs (hBMSCs) by detecting cell proliferation, alkaline phosphatase (ALP) activity and the expression of relevant osteogenic markers. Our results show that EGCG has a strong stimulatory effect on hBMSCs developing towards the osteogenic lineage, especially at a concentration of 5 μM, as evidenced by an increased ALP activity, the up-regulated expression of osteogenic genes and the formation of bone-like nodules. Further exploration has indicated that EGCG directes osteogenic differentiation via the continuous up-regulation of Runx2. The underlying mechanism might involve EGCG affects on osteogenic differentiation through the modulation of bone morphogenetic protein-2 expression. EGCG has also been found to promote the proliferation of hBMSCs in a dose-dependent manner. This might be associated with its antioxidative effect leading to favorable amounts of reactive oxygen species in the cellular environment. Our study thus indicates that EGCG can be used as a pro-osteogenic agent for the stem-cell-based therapy of osteoporosis.

Tea consumption didn't modify the risk of fracture: a dose-response meta-analysis of observational studies

Background

Fractures are important causes of healthy damage and economic loss nowadays. The conclusions of observational studies on tea consumption and fracture risk are still inconsistent. The objective of this meta-analysis is to determine the effect of tea drinking on the risk of fractures.

Methods

A comprehensive literature search was conducted in PubMed, Embase and reference lists of the relevant articles. Observational studies that reported an estimate of the association between tea drinking and incidence of fractures were included. A meta-analysis was conducted by the STATA software.

Results

A total of 9 studies involving 147,950 individuals that examined the association between tea consumption and risk of fractures were included in this meta-analysis. The odds risks (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The pooled OR of 9 observational studies for the tea consumption on risk of fracture was 0.89 (95% CI, 0.78-1.04). In the subgroup analyses, no significant association was detected in neither cohort studies (n = 3; OR, 0.97; 95% CI, 0.89-1.06) nor case–control studies (n = 6; OR, 0.91; 95% CI, 0.70-1.19), respectively. No significant association was detected in the dose–response meta-analysis.

Conclusions

Tea consumption might not be associated with the risk of fractures. The following large-sample and well-designed studies are required to confirm the existing conclusions.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5309904231178427.

Gene-by-diet interactions influence calcium absorption and bone density in mice

Dietary calcium (Ca) intake is needed to attain peak bone mineral density (BMD). Habitual low Ca intake increases intestinal Ca absorption efficiency to protect bone mass, but the mechanism controlling, and the impact of genetics on, this adaptive response is not clear. We fed 11 genetically diverse inbred mouse lines a normal (0.5%) or low (0.25%) Ca diet from 4 to 12 weeks of age (n = 8 per diet per line) and studied the independent and interacting effects of diet and genetics on Ca and bone metabolism. Significant genetic variation was observed in all bone, renal, and intestinal phenotypes measured including Ca absorption. Also, adaptation of Ca absorption and bone parameters to low dietary Ca was significantly different among the lines. Ca absorption was positively correlated to femur BMD (r = 0.17, p = 0.02), and distal femur bone volume/tissue volume (BV/TV) (r = 0.34, p < 0.0001). Although Ca absorption was correlated to 1,25 dihydroxyvitamin D (1,25(OH)2 D) (r = 0.35, p < 0.0001), the adaptation of Ca absorption to low Ca intake did not correlate to diet-induced adaptation of 1,25(OH)2 D across the 11 lines. Several intestinal proteins have been proposed to mediate Ca absorption: claudins 2 and 12, voltage gated Ca channel v1.3 (Cav1.3), plasma membrane Ca ATPase 1b (PMCA1b), transient receptor potential vanilloid member 6 (TRPV6), and calbindin D9k (CaBPD9k). Only the mRNA levels for TRPV6, CaBPD9k, and PMCA1b were related to Ca absorption (r = 0.42, 0.43, and 0.21, respectively). However, a significant amount of the variation in Ca absorption is not explained by the current model and suggests that novel mechanisms remain to be determined. These observations lay the groundwork for discovery-focused initiatives to identify novel genetic factors controlling gene-by-diet interactions affecting Ca/bone metabolism.

Tea and bone health: steps forward in translational nutrition

Osteoporosis is a major health problem in the aging population worldwide. Cross-sectional and retrospective evidence indicates that tea consumption may be a promising approach in mitigating bone loss and in reducing risk of osteoporotic fractures among older adults. Tea polyphenols enhance osteoblastogenesis and suppress osteoclastogenesis in vitro. Animal studies reveal that intake of tea polyphenols have pronounced positive effects on bone as shown by higher bone mass and trabecular bone volume, number, and thickness and lower trabecular separation via increasing bone formation and inhibition of bone resorption, resulting in greater bone strength. These osteoprotective effects appear to be mediated through antioxidant or antiinflammatory pathways along with their downstream signaling mechanisms. A short-term clinical trial of green tea polyphenols has translated the findings from ovariectomized animals to postmenopausal osteopenic women through evaluation of bioavailability, safety, bone turnover markers, muscle strength, and quality of life. For future studies, preclinical animal studies to optimize the dose of tea polyphenols for maximum osteoprotective efficacy and a follow-up short-term dose-response trial in postmenopausal osteopenic women are necessary to inform the design of randomized controlled studies in at-risk populations. Advanced imaging technology should also contribute to determining the effective dose of tea polyphenols in achieving better bone mass, microarchitecture integrity, and bone strength, which are critical steps for translating the putative benefit of tea consumption in osteoporosis management into clinical practice and dietary guidelines.

Bone mineral density, polyphenols and caffeine: a reassessment

Several studies have shown beneficial associations between tea consumption and bone mineral density (BMD) and fracture risk. Current investigations into potential mechanisms of benefit are focused upon the F and polyphenol components of tea. However, previous studies have pointed towards caffeine consumption as a potential risk factor for low BMD and high fracture risk. Tea, therefore, represents an interesting paradox as a mildly caffeinated beverage that may enhance bone health. Fruit and vegetable intake has also been associated with BMD, and it is now apparent that several fruit and vegetable components, including polyphenols, may contribute positively to bone health. Evidence surrounding the function(s) of polyphenol-rich foods in bone health is examined, along with more recent studies challenging the relevance of caffeine consumption to in vivo Ca balance. Plant foods rich in polyphenols such as tea, fruit and vegetables, as significant factors in a healthy diet and lifestyle, may have positive roles in bone health, and the negative role of caffeine may have been overestimated. The present review covers evidence of dietary mediation in positive and negative aspects of bone health, in particular the roles of tea, fruit and vegetables, and of caffeine, flavonoids and polyphenols as components of these foods. Since the deleterious effects of caffeine appear to have been overstated, especially in respect of the positive effects of flavonoids, it is concluded that a reassessment of the role of caffeinated beverages may be necessary.

Effect of green tea and Tai Chi on bone health in postmenopausal osteopenic women: a 6-month randomized placebo-controlled trial

Postmenopausal women with osteopenia received green tea polyphenols (GTP) supplement and/or Tai Chi exercise for 6 months. Bone turnover biomarkers, calcium metabolism, and muscle strength were measured. This study showed that GTP supplementation and Tai Chi exercise increased bone formation biomarkers and improved bone turnover rate. Tai Chi exercise increased serum parathyroid hormone. GTP supplementation, Tai Chi exercise, and the combination of the two all improved muscle strength in postmenopausal women with osteopenia.

INTRODUCTION

This study evaluated the effect of GTP supplementation and Tai Chi (TC) exercise on serum markers of bone turnover (bone-specific alkaline phosphatase, BAP, and tartrate-resistant acid phosphatase, TRAP), calcium metabolism, and muscle strength in postmenopausal osteopenic women.

METHODS

One hundred and seventy-one postmenopausal osteopenic women were randomly assigned to four groups: (1) placebo (500 mg starch/day), (2) GTP (500 mg GTP/day), (3) placebo + TC (placebo plus TC training at 60 min/session, three sessions/week), and (4) GTP + TC (GTP plus TC training). Overnight fasting blood and urine samples were collected at baseline, 1, 3, and 6 months for biomarker analyses. Muscle strength was evaluated at baseline, 3, and 6 months. One hundred and fifty subjects completed the 6-month study.

RESULTS

Significant increases in BAP level due to GTP intake (at 1 month) and TC (at 3 months) were observed. Significant increases in the change of BAP/TRAP ratio due to GTP (at 3 months) and TC (at 6 months) were also observed. Significant main effect of TC on the elevation in serum parathyroid hormone level was observed at 1 and 3 months. At 6 months, muscle strength significantly improved due to GTP, TC, and GTP + TC interventions. Neither GTP nor TC affected serum TRAP, serum and urinary calcium, and inorganic phosphate.

CONCLUSION

In summary, GTP supplementation and TC exercise increased BAP and improved BAP/TRAP ratio. TC exercise increased serum parathyroid hormone. GTP supplementation, TC exercise, and the combination of the two all improved muscle strength in postmenopausal women with osteopenia.

Green tea polyphenols and Tai Chi for bone health: designing a placebo-controlled randomized trial

BACKGROUND

Osteoporosis is a major health problem in postmenopausal women. Evidence suggests the importance of oxidative stress in bone metabolism and bone loss. Tea consumption may be beneficial to osteoporosis due to its antioxidant capability. However, lack of objective data characterizing tea consumption has hindered the precise evaluation of the association between tea ingestion and bone mineral density in previous questionnaire-based epidemiological studies. On the other hand, although published studies suggest that Tai Chi (TC) exercise can benefit bone health and may reduce oxidative stress, all studies were conducted using a relatively healthy older population, instead of a high-risk one such as osteopenic postmenopausal women. Therefore, this study was designed to test an intervention including green tea polyphenol (GTP) and TC exercise for feasibility, and to quantitatively assess their individual and interactive effects on postmenopausal women with osteopenia.

METHODS/DESIGN

One hundred and forty postmenopausal women with osteopenia (defined as bone mineral density T-score at the spine and/or hip between 1 to 2.5 SD below the reference database) were randomly assigned to 4 treatment arms: (1) placebo group receiving 500 mg medicinal starch daily, (2) GTP group receiving 500 mg of GTP per day, (3) placebo+TC group receiving both placebo treatment and TC training (60-minute group exercise, 3 times per week), and (4) GTP+TC group receiving both GTP and TC training for 24 weeks. The outcome measures were bone formation biomarker (serum bone alkaline phosphatase), bone resorption biomarker (serum tartrate resistant acid phosphatase), and oxidative DNA damage biomarker (urinary 8-hydroxy-2'-deoxyguanosine). All outcome measures were determined at baseline, 4, 12, and 24 weeks. Urinary and serum GTP concentrations were also determined at baseline, 4, 12, and 24 weeks for bioavailability. Liver function was monitored monthly for safety. A model of repeated measurements with random effect error terms was applied. Traditional procedures such as ANCOVA, chi-squared analysis, and regression were used for comparisons.

DISCUSSION

We present the rationale, design, and methodology of a placebo-controlled randomized trial to investigate a new complementary and alternative medicine strategy featuring a dietary supplement and a mind-body exercise for alleviating bone loss in osteopenic postmenopausal women.

Association between bone, body composition and strength in premenarcheal girls and postmenopausal women

AIM

The study examined whether associations between bone, body composition and strength are age dependent.

SUBJECTS AND METHODS

Two age levels (premenarcheal girls and postmenopausal women on HRT) were studied in a 10-month follow-up. Bone, lean and fat mass were measured by dual-energy X-ray absorptiometry (DXA), and strength was measured using an isokinetic dynamometer.

RESULTS

In girls, significant correlations were found between mass (lean, fat and body mass), strength and most bone characteristics (r = 0.15-0.93). At the proximal femur changes in bone mineral density (BMD) were moderately related to changes in body composition. In the women, body mass and lean mass were significantly correlated with most bone characteristics (r = 0.34-0.82). Low to moderate correlations were observed between changes in bone and changes in body composition. After controlling for lean mass the relation between strength and bone was no longer significant.

CONCLUSIONS

In premenarcheal girls, bone is partly determined by mass, with lean mass the most important predictor at the femoral sites. In postmenopausal women, lean mass is an important determinant of bone mineral content (BMC) and BMD, but changes in BMD are related to changes in fat. The relation between strength and BMD is mainly attributable to the relation between lean mass and BMD. The contributory effects of soft tissue to bone change over different life periods.

Green tea and bone metabolism

Osteoporosis is a major health problem in both elderly women and men. Epidemiological evidence has shown an association between tea consumption and the prevention of age-related bone loss in elderly women and men. Ingestion of green tea and green tea bioactive compounds may be beneficial in mitigating bone loss of this population and decreasing their risk of osteoporotic fractures. This review describes the effect of green tea or its bioactive components on bone health, with an emphasis on (i) the prevalence and etiology of osteoporosis; (ii) the role of oxidative stress and antioxidants in osteoporosis; (iii) green tea composition and bioavailability; (iv) the effects of green tea and its active components on osteogenesis, osteoblastogenesis, and osteoclastogenesis from human epidemiological, animal, as well as cell culture studies; (v) possible mechanisms explaining the osteoprotective effects of green tea bioactive compounds; (vi) other bioactive components in tea that benefit bone health; and (vii) a summary and future direction of green tea and bone health research and the translational aspects. In general, tea and its bioactive components might decrease the risk of fracture by improving bone mineral density and supporting osteoblastic activities while suppressing osteoclastic activities.

Green tea polyphenols mitigate deterioration of bone microarchitecture in middle-aged female rats

Our previous study demonstrated that green tea polyphenols (GTP) benefit bone health in middle-aged female rats without (sham, SH) and with ovariectomy (OVX), because of GTP's antioxidant capacity. The current study further evaluates whether GTP can restore bone micro-structure in both gonad-intact and gonadal-hormone-deficient middle-aged female rats. A 16-week study was performed based on a 2 (SH vs. OVX)x3 (no GTP, 0.1% GTP, and 0.5% GTP in drinking water) factorial design using 14-month-old female rats (n=10/group). An additional 10 rats were euthanized at the beginning of study to provide baseline parameters. Analysis using dual-energy X-ray absorptiometry, histomorphometry, and micro-computed tomography showed that GTP supplementation resulted in (a) increased trabecular volume, thickness, number, and bone formation of proximal tibia, periosteal bone formation rate of tibia shaft, and cortical thickness and area of femur, and (b) decreased trabecular separation and bone erosion of proximal tibia, and endocortical bone eroded surface of tibia shaft. We concluded that drinking water supplemented with GTP mitigated deterioration of bone microarchitecture in both intact and ovariectomized middle-aged female rats by suppressing bone erosion, enhancing bone formation, and modulating endocortical and cancellous bone compartments, resulting in a larger net bone volume.

(-)-Epigallocatechin gallate inhibition of osteoclastic differentiation via NF-kappaB

People who regularly drink tea have been found to have a higher bone mineral density (BMD) and to be at less risk of hip fractures than those who do not drink it. Green tea catechins such as (-)-epigallocatechin gallate (EGCG) have been reported to increase osteogenic functioning in mesenchymal stem cells. However, its effect on osteoclastogenesis remains unclear. In this study, we investigated the effect of EGCG on RANKL-activation osteoclastogenesis and NF-kappaB in RAW 264.7, a murine preosteoclast cell line. EGCG (10-100 microM) significantly suppressed the RANKL-induced differentiation of osteoclasts and the formation of pits in murine RAW 264.7 cells and bone marrow macrophages (BMMs). EGCG appeared to target osteoclastic differentiation at an early stage but had no cytotoxic effect on osteoclast precursors. In addition, it significantly inhibited RANKL-induced NF-kappaB transcriptional activity and nuclear translocation. We conclude that EGCG inhibits osteoclastogenesis through its activation of NF-kappaB.

Vitamin D insufficiency: disease or no disease?

Vitamin D insufficiency (VDI) is widely reported. In patients with normal PTH, the diagnosis rests on increases in fractional calcium absorption (FCA) when 25(OH)D increases above 30 ng/ml. However, estimates of increased FCA after correction of VDI vary dramatically, depending on study methods. We used a dual stable calcium isotope to clarify the impact of vitamin D repletion on FCA in postmenopausal women with VDI. We hypothesized that FCA would increase with vitamin D repletion. We studied postmenopausal women with VDI [25(OH)D = 16-24 ng/ml] and an estimated calcium intake <or=1100 mg daily. Exclusion criteria included hypercalcemia, hypercalciuria, renal insufficiency, nephrolithiasis, gastrointestinal disorders, osteomalacia, prior adult fragility fracture, baseline T-score < -3.0, and use of medications known to interfere with vitamin D or calcium metabolism. Each woman underwent inpatient FCA studies before and after correction of VDI. We used ergocalciferol 50,000 IU/d for 15 days to achieve vitamin D repletion. During each study, women consumed their typical diet. They ingested (44)Ca orally with breakfast and received (42)Ca intravenously. We collected urine for 24 h and measured its calcium isotope content by mass spectrometry. Eighteen women completed the study; all but two had normal PTH. During the first and second FCA studies, their mean 25(OH)D level was 22 +/- 4 and 64 +/- 21 ng/ml, respectively (p < 0.001). Subjects' average FCA was 24 +/- 7% initially and 27 +/- 6% after vitamin D repletion (p = 0.04). Thus, FCA increased by 3 +/- 1% with correction of VDI. Postmenopausal women with VDI experience small FCA increments with vitamin D therapy. In existing literature, this small change in FCA does not associate with lower fracture rates or consistently higher bone mass. Future studies should ascertain whether small FCA increments favorably affect the skeleton.

Protective effect of green tea polyphenols on bone loss in middle-aged female rats

Recent studies have suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. Findings that GTP supplementation resulted in increased urinary GTP concentrations and bone mass via an increase of antioxidant capacity and/or a decrease of oxidative stress damage suggest a significant role of GTP in bone health of women.

INTRODUCTION

Recent studies suggested that green tea polyphenols (GTP) are promising agents for preventing bone loss in women. However, the mechanism related to the possible protective role of GTP in bone loss is not well understood.

METHODS

This study evaluated bioavailability, mechanisms, bone mass, and safety of GTP in preventing bone loss in middle-aged rats without (sham, SH) and with ovariectomy (OVX). A 16-week study of 2 (SH vs. OVX) x 3 (no GTP, 0.1% GTP, and 0.5% GTP in drinking water) factorial design using 14-month-old female rats (n = 10/group) was performed. An additional 10 rats in baseline group were euthanized at the beginning of study to provide baseline parameters.

RESULTS

There was no difference in femur bone mineral density between baseline and the SH+0.5% GTP group. Ovariectomy resulted in lower values for liver glutathione peroxidase activity, serum estradiol, and bone mineral density. GTP supplementation resulted in increased urinary epigallocatechin and epicatechin concentrations, liver glutathione peroxidase activity and femur bone mineral density, decreased urinary 8-hydroxy-2'-deoxyguanosine and urinary calcium levels, but no effect on serum estradiol and blood chemistry levels.

CONCLUSION

We conclude that a bone-protective role of GTP may contribute to an increase of antioxidant capacity and/or a decrease of oxidative stress damage.

Interventions to Prevent Loss of Bone Mineral Density in Women Receiving Chemotherapy for Breast Cancer

Loss of bone mineral density (BMD) is a significant problem for women receiving breast cancer treatment. The purpose of this article is to present the state of the knowledge on BMD loss and analyze interventions to prevent BMD loss in women receiving breast cancer treatment. The data sources include primary research reports, review articles, and book chapters. With increased numbers of breast cancer survivors, BMD loss experienced with treatment is a significanthealth concern because of risks of osteoporosis and bone fractures. These long-term treatment effects may significantly impact patients' long-term morbitity and mortality. BMD screening as well as an assessment of physical activity and dietary history should be conducted with women undergoing breast cancer treatment. Bisphosphonates are effective in preventing BMD loss, and other interventions such as physical activity and dietary interventions need further testing. Oncology nurses are ideal candidates for implementing interventions to prevent BMD loss because of their understanding of cancer treatments, knowledge of health-related behaviors, and ability to teach patients about the positive health benefits of lifestyle changes.

Green tea catechin enhances osteogenesis in a bone marrow mesenchymal stem cell line

Green tea has been reported to possess antioxidant, antitumorigenic, and antibacterial qualities that regulate the endocrine system. Previous epidemiological studies found that the bone mineral density (BMD) of postmenopausal women with a habit of tea drinking was higher than that of women without habitual tea consumption. However, the effects of green tea catechins on osteogenic function have rarely been investigated. In this study, we tested (-)-epigallocatechin-3-gallate (EGCG), one of the green tea catechins, on cell proliferation, the mRNA expressions of relevant osteogenic markers, alkaline phosphatase (ALP) activity and mineralization. In a murine bone marrow mesenchymal stem cell line, D1, the mRNA expressions of core binding factors a1 (Cbfa1/Runx2), osterix, osteocalcin, ALP increased after 48 h of EGCG treatment. ALP activity was also significantly augmented upon EGCG treatment for 4 days, 7 days and 14 days. Furthermore, mineralizations assayed by Alizarin Red S and von Kossa stain were enhanced after EGCG treatment for 2-4 weeks in D1 cell cultures. However, a 24-h treatment of EGCG inhibited thymidine incorporation of D1 cells. These results demonstrated that long-term treatment of EGCG increases the expressions of osteogenic genes, elevates ALP activity and eventually stimulates mineralization, in spite of its inhibitory effect on proliferation. This finding suggests that the stimulatory effects of EGCG on osteogenesis of mesenchymal stem cells may be one of the mechanisms that allow tea drinkers to possess higher BMD.

Association between bone mineral density (DXA), body structure, and body composition in middle-aged men

The association between bone mass, body structure, and body composition was explored in 156 men, 40 years of AGE. Bone mineral density (total body, lumbar spine, left arm, and left leg) was obtained by dual-energy X-ray absorptiometry (DXA; Hologic QDR 4500A). Body structure was determined from a battery of anthropometric dimensions with a principal components analysis. Body composition was estimated with DXA. From the 24 anthropometric dimensions, three components were extracted and identified as muscle, fat, and skeletal length. Significant correlations between the muscle component and all BMD measurements (r = 0.28-0.44) were obtained. Except for BMD of the left arm, which correlated significantly, but negatively, with the fat component (r = -0.16), no significant relations were found between the fat component and BMD. There were significant correlations between lean mass, fat mass, and BMD measurements. The correlations were higher between lean mass and BMD (r = 0.22-0.44) than between fat mass and BMD (r = 0.08-0.24). The multiple regression analysis revealed that except for BMD of the left arm only lean mass or the muscle component, and not fat mass or the fat component, were independent predictors of BMD. It is concluded that the principal anthropometric determinant of BMD in middle-aged men is lean mass or muscle.

Leptin is expressed in and secreted from primary cultures of human osteoblasts and promotes bone mineralization

The adipose hormone leptin and its receptor are important for regulation of food intake and energy metabolism. Leptin also is involved in the growth of different tissues. In this study, we show the expression of leptin in primary cultures of normal human osteoblasts (hOBs) as evidenced by reverse transcriptase-polymerase chain reaction (RT-PCR) and immunocytochemistry. Release of leptin into the medium also was found. Leptin was not detected in commercially available hOBs (NHOst) or in three different human monoclonal osteosarcoma cell lines. Leptin expression was observed in OBs in the mineralization and/or the osteocyte transition period but not during the matrix maturation period. Furthermore, hOBs and osteosarcoma cell lines expressed the long signal-transducing form of the leptin receptor (OB-Rb) as shown by RT-PCR. We observed no significant changes in leptin or OB-Rb genes in hOBs after incubation with recombinant leptin, indicating no autoregulation of the leptin expression. Incubation of both hOBs entering the mineralization phase and osteosarcoma cell lines with recombinant leptin markedly increased the number of mineralized nodules as shown by alizarin S staining. These findings indicate that leptin may be of importance for osteoblastic cell growth and bone mineralization.

Postmenopausal function in context: biocultural observations on Amish, neighboring non-Amish, and Ifugao household health

Ecological approaches to female post-reproductive function must consider the social context and microenvironment of the household. A model integrating these environmental factors into the analysis of late-life well-being (operationally defined as household health) is presented and explored in three settings: an Old Order Amish community, the neighboring community of non-Amish, and an Ifugao community in the Philippine highlands. Intensive interview and observation of function were completed in a sample of at least 25 households in each community. The complex interaction of social and biological factors is explored in case studies and through multiple regression analysis with household health as the dependent variable. The results emphasize the importance of social support and assessing capabilities within the household. The results also suggest the need for natural field observation of work to better understand the influence of pacing and scheduling, necessity of work, and the role of environmental modification in postmenopausal function.

Effect of voluntary weight loss on bone mineral density in older overweight women

OBJECTIVES

To examine the effect of diet and exercise-induced weight loss on bone mineral density in overweight postmenopausal women

DESIGN

A 1-year prospective, randomized clinical trial.

SETTING

Two university medical school research centers.

PARTICIPANTS

Sixty-seven overweight postmenopausal women, a subset of the women who participated in the Trial of Nonpharmacological Interventions in the Elderly (TONE) to control hypertension. The participants were assigned randomly to one of four groups: usual care, weight loss only, sodium restriction only, or combined weight loss/sodium restriction.

INTERVENTION

All TONE participants in the treatment groups attended regular dietary intervention sessions to lose weight, reduce sodium intake, or both that they might refrain from using antihypertensive medications for a period of 15 to 36 months (median = 29 months).

MEASUREMENTS

Bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA), serum and urine markers of bone metabolism, and other demographic and clinical data were collected at baseline, 6 months, and 12 months.

RESULTS

Women assigned to the weight loss interventions lost 9.2 +/- 1.2 lbs (mean +/- SE) at 6 months and 7.7 +/- 2.0 lbs at 12 months compared with 1.8 +/- 1.0 lbs at 6 months and 1.9 +/- 1.6 lbs at 12 months for those assigned to no weight loss intervention (P < .0001). Weight loss was correlated with a decrease in total body BMD (P = .004) and an increase in osteocalcin (P = .004) after controlling for baseline bone measures, intervention assignment, and other baseline covariates. Regression analyses indicated that total body BMD decreased by 6.25 +/- 2.06 g/cm2 x 10-4 for each pound of weight loss.

CONCLUSIONS

Voluntary weight loss in overweight postmenopausal women is associated with modest decrease in total body BMD. Clinicians recommending weight loss for older postmenopausal women may need to include recommendations for reducing the risk of bone loss.

Tea drinking and bone mineral density in older women

BACKGROUND

High caffeine intake is reportedly a risk factor for reduced bone mineral density (BMD) in women. Most studies, however, are from populations in which coffee drinking predominates and is the major caffeine source. Tea contains caffeine but also has other nutrients, such as flavonoids, that may influence bone mass in different ways.

OBJECTIVE

We examined the relation between tea drinking and BMD in older women in Britain, where tea drinking is common.

METHODS

We measured BMD at the lumbar spine, femoral neck, greater trochanter, and Ward's triangle in 1256 free-living women aged 65-76 y in Cambridge, United Kingdom. Tea drinking was assessed by self-completed questionnaire and women were categorized as tea drinkers or non-tea drinkers.

RESULTS

There were 1134 tea drinkers (90.3%) and 122 non-tea drinkers (9.7%). Compared with non-tea drinkers, tea drinkers had significantly greater ( approximately 5%) mean BMD measurements, adjusted for age and body mass index, at the lumbar spine (0.033 g/cm(2); P = 0.03), greater trochanter (0.028 g/cm(2); P = 0.004), and Ward's triangle (0.025 g/cm(2); P = 0.02). Differences at the femoral neck (0.013 g/cm(2)) were not significant. These findings were independent of smoking status, use of hormone replacement therapy, coffee drinking, and whether milk was added to tea.

CONCLUSIONS

Older women who drank tea had higher BMD measurements than did those who did not drink tea. Nutrients found in tea, such as flavonoids, may influence BMD. Tea drinking may protect against osteoporosis in older women.

Calcium, dairy products and osteoporosis

Osteoporosis is a multifactorial disorder in which nutrition plays a role but does not account for the totality of the problem. 139 papers published since 1975 and describing studies of the relationship of calcium intake and bone health are briefly analyzed. Of 52 investigator-controlled calcium intervention studies, all but two showed better bone balance at high intakes, or greater bone gain during growth, or reduced bone loss in the elderly, or reduced fracture risk. This evidence firmly establishes that high calcium intakes promote bone health. Additionally, three-fourths of 86 observational studies were also positive, indicating that the causal link established in investigator-controlled trials can be found in free-living subjects as well. The principal reason for failure to find an association in observational studies is the weakness of the methods available for estimating long-term calcium intake. While most of the investigator-controlled studies used calcium supplements, six used dairy sources of calcium; all were positive. Most of the observational studies were based on dairy calcium also, since at the time the studies were done, higher calcium intakes meant higher dairy intakes. All studies evaluating the issue reported substantial augmentation of the osteoprotective effect of estrogen by high calcium intakes. Discussion is provided in regard to the multifactorial complexity of osteoporotic response to interventions and to the perturbing effect in controlled trials of the bone remodeling transient, as well as about how inferences can validly be drawn from the various study types represented in this compilation.